In a report issued in 1998, the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry proposed creation of a voluntary, private sector forum to promote collaboration across healthcare organizations in measuring and reporting on healthcare quality. After an extensive planning effort, the National Quality Forum (NQF) was established in 1999. In making their recommendations The Advisory Commission had a vision of a set of nationally accepted, publicly reported core measures of healthcare quality. Now five years later, the Commission's vision is on the verge of becoming reality. Largely through the efforts of NQF, standardized measures are becoming available for use at both the local and national levels. Measures and practices endorsed by NQF through its national voluntary consensus process now exist for serious adverse events, patient safety practices, adult diabetes care, and hospital care. Voluntary consensus on standardized measures for nursing care is underway and other measures will soon begin the consensus process. Although this progress has been encouraging, the critical question is what happens next? How does standardized measurement and public reporting become ingrained in the fabric of healthcare? How does it become part of the everyday activities that decision makers (including consumers) and healthcare professionals use to improve the nation's quality of care? Since its inception, the NQF Annual Meeting has been a forum for nurturing a sense of common purpose and promoting a shared framework for quality measurement, reporting, and improvement across the disparate stakeholders in the healthcare system. This 4th Annual Meeting will build on previous work and will begin to focus on implementation strategy and practice by: 1) documenting the current progress towards a national quality measurement and reporting system; 2) engaging stakeholders from across the healthcare system in the development of a shared, clearly articulated vision for employing quality measurement and reporting on all facets of healthcare decision making and delivery; 3) generating a sense of commitment on the part of each stakeholder towards managing for quality, and an understanding of what entails; and 4) developing a shared understanding and articulation of the interconnected roles of regulators, accreditors, and health professional educators in supporting national healthcare quality improvement.